Incidence and Risk of Celiac Disease after Type 1 Diabetes: A Population-Based Cohort Study Using The Health Improvement Network Database.
Year of Publication
2018 Sep 12
<p><strong>OBJECTIVE: </strong>To determine the incidence of and risk factors for development of celiac disese (CD) in individuals with type 1 diabetes.</p>
<p><strong>METHODS: </strong>Cohort study using The Health Improvement Network (THIN), a United Kingdom primary care database of >13 million people. Individuals with incident type 1 diabetes diagnosed at 1-35 years of age between 1995 and 2015 with no previous diagnosis of CD were included. Cox regression was used to identify risk factors for CD, including age at diabetes diagnosis and sex, while adjusting for year of diagnosis to control for potential rising incidence in CD over time.</p>
<p><strong>RESULTS: </strong>Subjects (n=9,180; 43% female) had a median observation time of 5.1 years (IQR 2.0-10.1). CD was diagnosed in 196 (2%) during follow up. Median time to diagnosis was 2.1 years, but 25% were diagnosed more than 5 years after diabetes diagnosis. Incidence (per 10,000 person-years) was greater in females (43.0 [95%CI 35.2-52.0]) vs males (26.8 [95%CI 21.5-32.9]). In multivariable Cox regression stratified by childhood- versus young adult-onset diabetes, younger age at diabetes diagnosis within childhood (HR 0.91 [95% CI 0.88-0.94]) and female sex among the adult-onset diabetes group (HR 3.19 [95% CI 1.39-7.34]) were associated with greater risk of CD.</p>
<p><strong>CONCLUSIONS: </strong>As expected, incidence of CD was higher in individuals with childhood-onset diabetes versus those with adult-onset diabetes. However, individuals with diabetes are at risk of developing CD throughout childhood and adulthood, and prolonged screening after diagnosis may be warranted. Prospective studies are needed in order to guide risk-stratified approaches to screening. This article is protected by copyright. All rights reserved.</p>